Jul 15, 2013 | Compliance, Legal, and Malpractice, Instruments & Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Pathology
Missed results in EHRs were related to information overload, electronic handoffs from one provider to another, and perceptions of poor usability of the EHR
Physicians often overlook important clinical laboratory test results when they get too many alerts in a day. This was one of several findings from a study designed to see how physicians responded to alerts delivered through an electronic health record system (EHR).
These findings will not surprise most pathologists and medical laboratory managers. Daily and weekly, they see how frequently “out of normal” test results can be reported to a referring physician. (more…)
Jun 14, 2013 | Instruments & Equipment, Laboratory Hiring & Human Resources, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
DoD/VA public relations debacle could provide valuable lessons for laboratory organizations looking to implement large-scale IT or operational innovations
Even as the federal government is incentivizing hospitals, physicians, and all types of healthcare providers to adopt and use electronic health records (EHRs), it has admitted failure in its own attempt to integrate EHRs that serve two of the nation’s largest health benefits programs.
Those two programs, the Veterans Administration (VA) and the Department of Defense (DoD), provide healthcare to millions of individuals. In recent years, the two agencies have spent hundreds of millions of dollars to interface and integrate their respective EHR systems. (more…)
Mar 1, 2013 | Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology
Final Stage 2 rules give providers another year to meet Stage 1 ‘meaningful use’ criteria and shorten Stage 2 requirements from one-year to just 90 days
Clinical laboratory managers and pathologists may be interested to know that, over the fall months, the U.S. Department of Health and Human Services (HHS) released three new rules that affect users of health information technology (HIT).
One rule covers Stage Two of Meaningful Use and includes guidance on how providers should address the need to encrypt patient data. The second rule updates eligibility criteria that providers implementing electronic health record (EHR) systems must meet to qualify for federal incentives. Because medical laboratories and pathology groups maintain ongoing electronic interfaces with hospitals and office-based physicians, it is useful to know some of the key elements of these three recently issued federal regulations. The third rule establishes a date for conversion to ICD-10.
The new regulations were contained in a 1,354-page document published in the Federal Register. These rules represent “a tsunami of change” for providers, observed Patricia B. Wise, RN, MS, MA, COL (USA ret’d), Vice President for healthcare information systems for the Chicago-based Healthcare Information Exchange and Management Systems Society (HIMSS). Wise was quoted in a Modern Healthcare story. (more…)
Nov 12, 2012 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Researchers looked at how physicians in ambulatory settings followed up on the results of medical laboratory tests
Studies performed in the United States show that, for ambulatory patients, doctors fail to follow up on as many as two-thirds of medical laboratory test results and up to one-third of radiology reports! A recent review of 19 of these studies also showed that these failures resulted in serious lapses in patient care.
It was researchers at the University of New South Wales (UNSW) who undertook a systematic review of evidence of failure to follow up on diagnostic test results and how this impacted ambulatory patients. The review was the first of its kind, internationally, according to a story published on UNSW’s Australian Institute of Health Innovation (AIHI) website.
Failure to Follow Up on Results of Clinical Laboratory Tests
“Failure to follow-up [on medical laboratory and radiology] test results for patients is a critical safety issue which requires urgent attention,” declared lead researcher Joanne L. Callen, Ph.D., in a story published by Medical Xpress. “Without knowledge of the size and effect of the problem, many clinicians may underestimate its extent and consequences.” Callen is an Associate Professor at UNSW and works as a Senior Research Fellow in the Centre for Health Systems and Safety Research. The Journal of General Internal Medicine published the review article.
The research team examined 19 studies that were conducted in the United States, where most of the research is being done, according to Callen. The U.S. studies quantified the extent of the failure to follow up clinical laboratory and radiology tests. Settings included ambulatory patients attending outpatient clinics, academic medical centers, community health centers, and primary care practices.
The investigators found that doctors in the United States fail to follow up as many as 62% of clinical pathology laboratory tests and up to 35% of radiology reports. This means that they are missing critical diagnoses. In turn, this causes delays in treatments for many conditions, including cancer, the AIHI story stated.
Researchers at the University of New South Wales (UNSW) found that doctors fail to follow up as many as 62% of clinical laboratory tests and up to 35% of radiology reports that they ordered for their patients. The UNSW study team reviewed 19 studies involving ambulatory patients conducted in the United States, where most of the research on this subject has been conducted. (Photo by advantagemedlab.com.)
The 19 studies included in the review reported a wide variation in the extent of diagnostic tests not followed up by the ordering physician. For medical laboratory tests, results varied from 6.8% (79/1163) to 62% (125/202). For radiology, the results varied from 1.0% (4/395) to 35.7% (45/126), according to the review abstract.
Studies Showed Improved Test Follow Up With Use of Electronic Systems
The practices and processes currently used are varied and unsystematic, the review authors wrote. They noted that most primary care practices are not using electronic health record (EHR) systems. Further, they stated that most are communicating with multiple clinical laboratories that are often not electronically connected.
“Quantitative evidence of the effectiveness of electronic test management systems was limited,” the authors observed in the abstract. However, they found that “there was a general trend towards improved test follow up when electronic systems were used.”
The researchers also pointed out that feedback on medical errors is essential in order to counteract overconfidence in decision making vis-à-vis diagnostic accuracy. “Without knowledge of the size of the problem, many clinicians may underestimate its extent and therefore fail to take any action to improve the process,” they stated in the abstract.
The researchers concluded that solutions to the problem of missed diagnostic test results require a multi-faceted approach. Their recommendations included addressing the following areas:
- policies relating to responsibility, timing and process of notification;
- integrated IT and communications technologies;
- consideration of the multidisciplinary nature of the process; and,
- the role of the patient as a possible safety net against error.
Pathologists Can Read the Original UNSW Paper
Pathologists and clinical laboratory managers may want to access the original paper published by Callen and her colleagues. The paper’s statistics and findings may be useful in educating physicians about why failure to follow up on medical laboratory test results is a bigger problem than currently acknowledged.
In fact, publication of this study creates another opportunity for medical laboratories to add value to clinicians by helping them avoid missing key lab test results that might be overlooked. Such assistance is particularly important at a time when an important component of physician reimbursement is based on improvement in patient outcomes.
—Pamela Scherer McLeod
Related Information:
Doctors failing to follow-up test results
Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review
Calls for patients to take charge of medical tests
Medical test results – why no news doesn’t mean good news
Oct 8, 2012 | Digital Pathology, Laboratory News, Laboratory Pathology, News From Dark Daily
Fast-moving trends are reshaping how clinical laboratories and pathology groups use information technology to deliver more value to physicians and patients
In the field of medical laboratory informatics, there is an emerging trend of great importance to both clinical laboratories and pathology groups. It is becoming increasingly tougher for hospital labs to select a “best-of-breed” laboratory information system (LIS). That’s because more hospital administrators are opting for a single “enterprise-wide” informatics/EHR solution that commonly includes an LIS that is not the first choice of laboratory management.
“We are now at a very significant tipping point in the field of pathology informatics,” declared Bruce Friedman, M.D., Active Emeritus Professor of Pathology at the University of Michigan Medical School. “After more than three decades of stability and broad acceptance of best-of-breed LISs and close collaboration between LIS vendors and pathology professionals, the enterprise-wide-solution is emerging as a favorite of hospital CIOs and CEOs. (more…)
